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A student receives a whooping cough vaccination in Huntington Park, Calif. California parents are deciding against vaccinating their kindergarten-age children at twice the rate they did seven years ago. (Irfan Khan/Los Angeles Times/MCT)

JEFFERSON CITY — Amid an alarming spike in hepatitis A cases and a failed push by state lawmakers to prohibit discrimination against children who aren’t vaccinated, Missouri health officials have signed a contract designed to boost vaccination rates across the state.

State purchasing records show the Missouri Department of Health and Senior Services has awarded a no-bid contract to the Missouri Primary Care Association to raise the vaccination rate among adolescents.

The agreement will pay the organization $125,000 a year to focus on at least five vaccines, including influenza, hepatitis A and HPV.

Contract talks began before health officials warned last week that a hepatitis A outbreak in the state could grow worse if it spreads to urban areas like St. Louis and St. Louis County.

The agency said the state has recorded 414 cases of the virus since September 2017. More than 230 people have been hospitalized and two people have died.

Hot spots include Franklin, Butler and Howell counties.

In previous years, only about 10 cases were reported annually, Randall Williams, the state's health and senior services director, told the Post-Dispatch.

Hepatitis A is a viral infection of the liver. It usually spreads when a person ingests the virus from objects, food or drinks contaminated by undetected amounts of stool from an infected person.

Symptoms include loss of appetite, nausea, fatigue, fever, stomach pain, brown-colored urine and light-colored stools. Yellowing of the skin or eyes might also occur. People can become ill up to seven weeks after being exposed to the virus.

“The main risk factor that we're seeing among the cases is illicit drug use — either injection or non-injection drugs,” said Rachael Hahn, chief of communicable disease control and prevention for the state health department.

She said recreational drug users, the homeless, men who have sex with men, people being treated for substance abuse and people who work or have been detained in a detention center are at heightened risk of hepatitis A exposure.

“Any of those people who might fit into one of those risk groups, I’d recommend that they go ahead and get a vaccination right away,” Hahn said.

Under the new contract, the primary care association will work with community health centers that oversee 13 clinics across the state.

The clinics will be responsible for instituting programs to increase vaccination rates, including developing a patient reminder system.

Health department spokeswoman Lisa Cox said each of the clinics’ immunization rates are below the goals set by the federal government for 2020.

The rates will be reassessed in June 2020 to determine if the program has been successful.

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The push by Republican Gov. Mike Parson’s administration follows a debate this spring by state lawmakers over proposed legislation favored by people who believe vaccinations are harmful.

One proposal would have prohibited discrimination against children who haven’t been vaccinated. Another would have required doctors to provide patients with information about the “benefits and risks of each vaccine.”

Republican Rep. Lynn Morris, an Ozark pharmacist who sponsored the discrimination legislation, said people should have a choice and not be punished for deciding against vaccinations.

Under his legislation, state law would prohibit public schools, universities, day care facilities and doctors from turning a child away if they have received an exemption from vaccinations because of medical or religious reasons.

The other proposal, sponsored by Rep. Dottie Bailey, R-Eureka, would require a health care provider who administers vaccines to provide the benefits and risks of each vaccine and other specific information about the contents of a vaccine.

It also would require a parent to be told how to report a vaccine-adverse event.

Both proposals failed to advance in the House.

Jack Suntrup of the Post-Dispatch contributed to this report.

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